In the right situation, I’m all for limited government. Reduce foreign interventionism and the surveillance state. Get government out of the private lives of individuals–including regulation of reproductive rights. Unfortunately, when Republicans talk about limited government it generally turns out to be reducing the safety net or cutting important functions which often represent a very small part of the budget. The Wall Street Journal reports, CDC to Scale Back Work in Dozens of Foreign Countries Amid Funding Worries:

The Centers for Disease Control and Prevention plans to scale back or discontinue its work to prevent infectious-disease epidemics and other health threats in 39 foreign countries because it expects funding for the work to end, the agency told employees.

The CDC currently works in 49 countries as part of an initiative called the global health security agenda, to prevent, detect and respond to dangerous infectious disease threats. It helps expand surveillance for new viruses and​ ​drug-resistant bacteria, modernize laboratories to detect dangerous pathogens​and train workers who respond to epidemics.

Global health organizations said critical momentum will be lost if epidemic prevention funding is reduced, leaving the world unprepared for the next outbreak. The risks of deadly and costly pandemic threats are higher than ever, especially in low- and middle-income countries with the weakest public health systems, experts say. A rapid response by a country can mean the difference between an isolated outbreak and a global catastrophe. In less than 36 hours, infectious disease and pathogens can travel from a remote village to major cities on any continent to become a global crisis.

On Monday, a coalition of global health organizations representing more than 200 groups and companies sent a letter to U.S. Health and Human Services Secretary Alex Azar asking the administration to reconsider the planned reductions to programs they described as essential to health and national security.

“Not only will CDC be forced to narrow its countries of operations, but the U.S. also stands to lose vital information about epidemic threats garnered on the ground through trusted relationships, real-time surveillance, and research,” wrote the coalition, which included the Global Health Security Agenda Consortium and the Global Health Council.

The coalition also warned that complacency after outbreaks have been contained leads to funding cuts, followed by ever more costly outbreaks. The Ebola outbreak cost U.S. taxpayers $5.4 billion in emergency supplemental funding, forced several U.S. cities to spend millions in containment, disrupted global business and required the deployment of the U.S. military to address the threat.

“This is the front line against terrible organisms,” said Tom Frieden, the former CDC director who led the agency during the Ebola and Zika outbreaks. He now heads Resolve to Save Lives, a global initiative to prevent epidemics. Referring to dangerous pathogens, he said: “Like terrorism, you can’t fight it just within our borders. You’ve got to fight epidemic diseases where they emerge.”

…Officials at the CDC, the Department of Health and Human Services and the National Security Council pushed for more funding in the president’s fiscal 2019 budget to be released this month.

Last night Bernie Sanders was one of five Democratic responses to the State of the Union Address, including Joe Kennedy III’s official response. Sanders criticized Trump for promising to provide “health insurance for everybody,” with “much lower deductibles,” but instead supporting legislation that “would thrown up to 32 million people off of the health care they had while, at the same time, substantially raising premiums for older Americans.”

Sanders noted that Trump had promised “promised not to cut Social Security, Medicare or Medicaid.” Instead, “he supported a Republican Budget Resolution that proposed slashing Medicaid by $1 trillion and cutting Medicare by $500 billion. Further, President Trump’s own budget called for cutting Social Security Disability Insurance by $64 billion.”

In addition to calling out Trump for breaking his campaign promises, Sanders noted many things which Trump failed to talk about, including climate change and voter suppression.

Sanders also stated that the Russians “interfered in our election in 2016, is interfering in democratic elections all over the world.” While technically true, this plays into the hysteria being spread by Democrats, often based upon misinformation. While true that Russia meddled in our election, this must be kept in context that Russia has meddled in elections for decades–just as the United States has frequently meddled in foreign elections. Russian meddling has also been highly exaggerated. There is also no evidence that Russia had any effect on the election results. The information obtained through the Congressional hearings has shown that claims about Russian tampering with the election have been have been of little consequence. Similarly, multiple media reports of Russian hacking were subsequently retracted as false. I would hope that Sanders would know better to play into the misleading claims of Democrats who are distorting the facts to deny the blame they deserve for losing to Donald Trump due to choosing a candidate as terrible as Hillary Clinton, along with playing into the hands of neocons who are distorting Russian electoral interference as they used false claims of WMD in Iraq to promote their goal of regime change in Russia.

It is fitting that Donald Trump, who claimed that “I alone can fix it,” couldn’t make it through his entire first year without breaking the government. Donald Trump has been among the worst presidents ever. However, while the past year under Trump might have been the worst of times, it was not the worst of all possible times. Trump’s first year has been terrible, but we must also be appreciative all those spared from dying in Hillary’s wars over the past year.

Donald Trump and the Republicans have been terrible on many issues, including health care, race, and immigration. As I had previously predicted, Trump has been totally incoherent on foreign policy. He has escalated a potential nuclear crisis in North Korea, but we also must not forget that Hillary Clinton was largely responsible for the situation and peace would have probably have been impossible if she was in the White House. Clinton’s push to overthrow Muammar Qaddafi based upon lies after he surrendered his nuclear weapons, along with her joining with her neocon allies in lying us into the Iraq war, have been cited by both Kim Jong-un and Vladimir Putin as reasons for their nuclear buildup and other foreign policy actions.

Donald Trump’s relations with Russia have been mixed, and evidence has grown of both a history of financial crimes and an attempt at a cover-up over the past year. At least Trump’s financial crimes are under investigation, while Democrats regularly make excuses for the influence peddling of Bill and Hillary Clinton.

The irony is that, after the risk of deterioration of relations with Russia and a return to a Cold War atmosphere was feared by many should Clinton become president, Clinton has managed to create hysteria over Russia without even being elected. While Trump is probably guilty of money laundering and a obstruction of justice, the evidence to date has contradicted conspiracy theories which appear to have been fabricated Clinton and the DNC to blame Clinton’s loss on Russia. With Clinton continuing to promote belligerence towards Russia even out of office, using conspiracy theories to get Democrats to embrace her neoconservative interventionism, it is of considerable concern as to how much greater harm Clinton could be doing in the White House.

Donald Trump has been terrible for civil liberties as president, including his attacks on the press. It must not be forgotten that even before the election Clinton had far right wing views on civil liberties which were not all that different from Trump’s. Donald Trump has ignored the norms of a democratic society, but since the election Clinton has also continued her attack on civil liberties and has attacked the fundamental principles of democracy, including the legitimacy of election results. Both Clinton and Trump have cited fake news, which often means information critical of them, as justification to call for censorship.

While many Republicans have little respect for civil liberties, in the past year we have seen Democrats engage in McCarthyism as part of their anti-Russia hysteria. The Democratic Party as a whole turned out to be worthless when faced with a vote to renew and expand warrantless surveillance as many joined with Republicans. If many Democrats were unwilling to stand up to Donald Trump on a fundamental civil liberties issue, I would expect even fewer to resist calls for increased powers by an authoritarian like Hillary Clinton.

Donald Trump has been a terrible president, but at least his faults are widely recognized, and his falsehoods are regularly exposed. Donald Trump might have authoritarian tendencies, but if so he is a very weak authoritarian. He has brought about serious damage to the entire Republican and conservative brands, likely doing far less damage than Hillary Clinton would have been capable of.

At the moment we are waiting in limbo for a couple of big stories to break. We don’t know yet if there will be a government shutdown. (If there is a shutdown, will drone attacks and NSA surveillance be halted? Unfortunately no.) One way to avert a government shutdown would be to tell Trump that McDonald’s will shut down if the government does.

The DNC Rules and Bylaws Committee meets tomorrow to vote on the recommendations of the Unity Reform Commission–which are very limited and do not do enough. If the DNC rejects these recommendations the Democratic Party will be demonstrating a contempt for democracy which would make Thomas Jefferson, along with FDR, roll over in their graves. It could also be said that they already demonstrated this in 2016.

While waiting for the answers, I decided to go back and quote interesting passages from Michael Wolff’s recent book, Fire and Fury: Inside the Trump White House. I previously noted some selections from the book here. There were further quotations regarding Wolff’s view that the Russia scandal is about money laundering, and not about collusion to affect the election 2016 election results, here. The question of Trump’s state of mind was reviewed here. Here are some additional items of interest.

It isn’t as crude as grabbing them by the pussy, but this aspect of Trump’s views is rather demeaning to the women working for him:

While Trump was in most ways a conventional misogynist, in the workplace he was much closer to women than to men. The former he confided in, the latter he held at arm’s length. He liked and needed his office wives, and he trusted them with his most important personal issues. Women, according to Trump, were simply more loyal and trustworthy than men. Men might be more forceful and competent, but they were also more likely to have their own agendas. Women, by their nature, or Trump’s version of their nature, were more likely to focus their purpose on a man. A man like Trump.

Prior to the election I often compared the foreign policy views of Clinton and Trump. I noted that while Trump was not interested in neocon foreign interventionism like Clinton, his views on foreign policy were too incoherent to provide a better alternative. Wolff’s description of Trump’s foreign policy views goes along with my characterization of them as incoherent:

If the Trump White House was as unsettling as any in American history, the president’s views of foreign policy and the world at large were among its most random, uninformed, and seemingly capricious aspects. His advisers didn’t know whether he was an isolationist or a militarist, or whether he could distinguish between the two. He was enamored with generals and determined that people with military command experience take the lead in foreign policy, but he hated to be told what to do. He was against nation building, but he believed there were few situations that he couldn’t personally make better. He had little to no experience in foreign policy, but he had no respect for the experts, either.

While Hillary Clinton campaigned against Bernie Sanders’ Medicare for All proposal, there was a surprising supporter of the plan in Washington–Donald Trump:

All things considered, he probably preferred the notion of more people having health insurance than fewer people having it. He was even, when push came to shove, rather more for Obamacare than for repealing Obamacare. As well, he had made a set of rash Obama-like promises, going so far as to say that under a forthcoming Trumpcare plan (he had to be strongly discouraged from using this kind of rebranding — political wise men told him that this was one instance where he might not want to claim ownership with his name), no one would lose their health insurance, and that preexisting conditions would continue to be covered. In fact, he probably favored government-funded health care more than any other Republican. “Why can’t Medicare simply cover everybody?” he had impatiently wondered aloud during one discussion with aides, all of whom were careful not to react to this heresy.

Of course this has no practical value, with Trump having no understanding of the details of health care legislation and no interest in really doing the work to promote a plan, allowing Congressional Republicans to push their agenda.

I have been wondering for quite a while whether Donald Trump’s primary problem is dementia or psychiatric. He has shown some signs of possible dementia, but they were hardly definitive. Psychiatrists have also been questioning Trump’s mental health. We probably now have an answer to the question of whether Trump’s problem is dementia versus psychiatric. Reportedly Donald Trump scored a 30 out of 30 on the Montreal Cognitive Assessment. The test is a pretty reliable indicator of dementia and with a score of 30 and, assuming the report of Trump’s score is factual, it is now doubtful that he has dementia.

With dementia ruled out, Trump should have thorough psychiatric testing, but it is unlikely that he will ever consent to this. The only way to force him to would by trying to remove him from office under the provisions of the 25th Amendment, and this is unlikely to happen unless there is a very clear deterioration .

“These laws allow local farmers to grow marijuana that can then be sold to dispensaries where it is sold legally,” said the economist Evelina Gavrilova, one of the study’s authors. “These growers are in direct competition with Mexican drug cartels that are smuggling the marijuana into the US. As a result, the cartels get much less business.”

The knock-on effect is a reduction in levels of drug-related violence. “The cartels are in competition with one another,” Gavrilova explained. “They compete for territory, but it’s also easy to steal product from the other cartels and sell it themselves, so they fight for the product. They also have to defend their territory and ensure there are no bystanders, no witnesses to the activities of the cartel.

“Whenever there is a medical marijuana law we observe that crime at the border decreases because suddenly there is a lot less smuggling and a lot less violence associated with that.”

In other words, the experience with marijuana prohibition is similar to what we experienced with alcohol prohibition.

This also shows a failure of our political system. Despite ending prohibition being both the sensible choice, and a choice favored by a large majority of Americans, there has been little pressure to change the system from either major political party. While the two parties find plenty to fight over, there is little difference over what they parties actually do on far too many issues.

The Goldwater Rule has received considerable attention this year with the election of Donald Trump. The rule was put into place to dissuade psychiatrists from talking about the mental health of politicians without actually doing an exam after some had speculated about Barry Goldwater’s mental health. As I noted in July, the American Psychoanalytic Association has released an emailed statement freeing its members to give opinions on the mental state of Donald Trump. The controversy has continued with the publication of a book entitled The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.

The New England Journal of Medicine has an article by a psychiatrist, Claire Pouncey, resonding to criticism of the book and making an argument for psychiatrists to be able to comment on the mental health of Donald Trump. Here is a portion:

…in October, psychiatrist Bandy Lee published a collection of essays written largely by mental health professionals who believe that their training and expertise compel them to warn the public of the dangers they see in Trump’s psychology. The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President rejects the position of the American Psychiatric Association (APA) that psychiatrists should never offer diagnostic opinions about persons they have not personally examined.Past APA president Jeffrey Lieberman has written in Psychiatric News that the book is “not a serious, scholarly, civic-minded work, but simply tawdry, indulgent, fatuous tabloid psychiatry.” I believe it shouldn’t be dismissed so quickly…

The relevance of the Goldwater rule has spiked in the past 2 years in the setting of Trump’s candidacy and now presidency. There are good reasons to respect the intention of Section 7.3. Most psychiatrists want to teach the public about the myriad presentations of mental illness and character pathology and not to oversimplify, stigmatize, promote stereotypes, or disparage the persons whose mental health we work to improve. We believe that people with mental illness can flourish and contribute to our communities, and on the flip side, we do not assume that everyone who behaves erratically or earns public disapprobation is mentally ill. Most psychiatrists do not think we have superpowers that let us know the inner thoughts and psychological workings of strangers. Section 7.3 reminds us to remain humble about the claims we can reasonably make and to present ourselves responsibly for the sake of our patients and our profession.

Increasingly, however, some psychiatrists are expressing professional concern about Trump’s public remarks and behaviors and what they mean for public safety. Lee and her coauthors clearly take themselves to be fulfilling the moral obligation of Section 7 by using their specific expertise as mental health professionals.

The Goldwater rule, like the other APA annotations, is meant to clarify a principle of medical ethics, not contradict it. Yet in March 2017, shortly after Trump’s presidential inauguration, the APA broadened the rule to apply to “any opinion on the affect, behavior, speech, or other presentation of an individual that draws on the skills, training, expertise, and/or knowledge inherent in the practice of psychiatry”5 — an expansion that would silence psychiatrists who want to honor the moral obligation of Section 7 by educating the public about the dangers they see in Trump’s psychology. The problem is that psychiatric diagnostic terminology has been colloquialized, so the public and the press use it to describe Trump, but when a psychiatrist does so, use of the same words is considered to be a formal diagnosis (at least in the eyes of the APA). As a result, psychiatrists are the only members of the citizenry who may not express concern about the mental health of the president using psychiatric diagnostic terminology.

The Dangerous Case of Donald Trump challenges the APA position that a psychiatrist cannot know enough about a person she has not interviewed to formulate a diagnostic impression. Contrary to the APA, a physician who has not formally evaluated a patient is not making a diagnosis in the medical sense, but rather using diagnostic speculation and terminology informally, with the benefit of education. That characterization applies to the orthopedist or physical medicine specialist speculating on the knee injury of the football player limping off the field and the dermatologist wincing at a stranger’s melanoma in the grocery line as well as to the psychiatrist interpreting Trump’s public statements. Physicians don’t stop knowing what we know when we leave the clinic. Psychiatric terminology has become part of the common parlance, and the authors in Dangerous Case describe and define that terminology much better than, say, Ralph Northam. The question is whether psychiatrists are the ones we should hear it from.

I expect that the APA will denounce and dismiss this book and its authors, but I encourage others not to do so. Dangerous Case is unapologetically provocative and political, and the authors clearly take themselves to be contributing to the improvement of the community and the betterment of public health, as the AMA (and APA) principles of medical ethics direct. Dangerous Case will have supporters and detractors for good reasons — some political, some social, some psychiatric — that have much more to do with views of Trump’s mental health than with the Goldwater rule. I believe that the APA, in the interest of promoting public health and safety, should encourage rather than silence the debate the book generates. And it should take caution not to enforce an annotation that undermines the overriding public health and safety mandate that applies to all physicians. Standards of professional ethics and professionalism change with time and circumstance, and psychiatry’s reaction to one misstep in 1964 should not entail another in 2017.

Are we now Italy? The Hill reports that a porn star has announced her candidacy for the Democratic nomination:

A porn star and a rapper say they have what it takes to win the White House in 2020.

Cherie DeVille, who’s starred in such videos as “Ass Planet” and “Hot Tub Hottie,” says she was inspired to run for office out of her “personal frustration for the current political climate.”

When Donald Trump won the election last year, DeVille — who’s running alongside rapper Coolio — says she sobbed. “I didn’t cry because I hated [Trump] specifically, I cried because of what I felt that meant for the direction our country was going in.”

“We’re voting for people as if we’re on a reality television show, and my concern is if we continue to purely vote for celebrities, or political figures, or the most entertaining, they’re not always going to be quality politicians,” DeVille told ITK on Tuesday.

So the 39-year-old adult film performer decided to toss her hat in the political ring, saying she’s planning on running as a Democrat.

“If our criteria now for becoming a political official is minor celebrity, I have that,” says DeVille, who boasts 190,000 Twitter followers. “I feel like I can be potentially what I’m feeling the American people — for better or for worse — want, which is interesting news, scandalous news, you know, not ‘boring’ political news.”

“But at the same time [I can] do what the American people really need,” she continues, which is “having a person with integrity, and having someone listen to the people, and actually care about America in public office.”

A former physical therapist, DeVille — whose campaign slogan is “Make America F—— Awesome Again” — says a lot of people “giggle” when they learn that “Gangsta’s Paradise” rapper Coolio is running as her VP.

Portions of the left and libertarian right do often share some views in common. For example, CounterPunch today has a post on The Logic of Drug Legalization:

The Drug Lords of today exist because of the extraordinary profits resulting from criminalization. Estimates run in the half a trillion range globally per year. By way of comparison there are only twenty or so countries with a national economy of that size. The situation is exactly analogous to the prohibition era. When gunfights, beatings, murders and firebombs were the business strategy of choice for the pushers of alcohol. Once booze was legalized the bootleggers were immediately driven out of business. Alcohol is heavily taxed today there are however no Bootlegging Lords on the playground pushing cheaper booze on our children.

Nor would such pushers exist for any other drug that we might choose to legalize. Sure the criminals could evade the cost of taxes on their product but there are enormous costs incurred by criminal enterprises that don’t apply to legal ones. This is why marijuana today is sold for hundreds of times what it costs to grow. Our legal producers will not be faced with those costs and so can sell to us below current prices on the street. With profit margins cut to the bone the ‘dread lords and masters’ that control the illegal drug market today will simply melt away like the last snow before the advancing spring…

Periodically I see articles from people who have good intentions but don’t understand how health care really works argue that we should end private practice and have all doctors become employees to save costs. The reality is that this trend has increased costs rather than save money, as discussed in this article at Modern Healthcare entitled Hospital-employed physicians drain Medicare:

“When hospitals grow their physician network, with a subsidy of $150,000 to $200,000 per physician, they have to cover those costs by driving ancillary services and (getting more people) in hospital beds,” said Dr. Jeffrey LeBenger, CEO of Summit Health Management, an integrated, physician-led independent physician group that includes some 800 doctors. One of the main drivers of physician acquisitions is to increase referral networks, he said.

Donald Trump is talking about having met with the President of the Virgin Islands (who technically would be himself). He says that tomorrow he will meet with the Commander-in-Chief of the US armed forces. He has also suggested that Mike Pence schedule a meeting with the President of the Senate. This is the guy who was boasting about his IQ earlier in the week.

Columbia is talking about hiring Hillary Clinton to be a professor. Can they afford her speaking fees? Do university’s have any form of ethics agreements before hiring someone? If so, they should know that she totally ignored the ethics agreement she entered into before taking her last job as Secretary of State.

Question of the Day: Which organization is more wracked in scandal and chaos: The Weinstein Co. or the Trump White House?

Eighteen states are suing the Trump administration over stopping the ObamaCare subsidies. The Pottery Barn Rule should now take effect with regards to Donald Trump and the Affordable Care Act–You Break It, You Own It.

I’ve been saying all along that the real Russia story is about the money, not altering the 2016 election results. NBC News is reporting that Paul Manafort had a $60 million relationship with a Russian oligarch.

Quote of the Day: “For the last 24 hours, Donald Trump has been the president of busy town. This morning, he signed an executive order to get rid of some key provisions of Obamacare. For instance, the care part.” –Stephen Colbert

Donald Trump lacks long term ties to the Republican Party, and has started to figure out that his best shot of passing legislation might be to work with the Democrats. If he can bring along part of the Republican Party he might have a better chance of passing legislation by working with the Democrats than by trying to pass legislation with Republican votes alone. With the inability of Republicans to repeal Obamacare, Trump has upset many Republicans by calling Chuck Schumer to seek a path forward on healthcare.

Trump previously worked with the Democratic leadership on three-month government funding measure, debt limit hike, and hurricane aid. He has also spoken with them about Deferred Action for Childhood Arrivals (DACA), with no agreement reached yet.

I called Chuck Schumer yesterday to see if the Dems want to do a great HealthCare Bill. ObamaCare is badly broken, big premiums. Who knows!

Trump has verified that he called Schumer on Twitter but so far Schumer has not seen a path for the two to work together. The Hill reports:

Senate Minority Leader Charles Schumer (D-N.Y.) said Saturday he told President Trump that Democrats would be open to stabilizing the health-care system, but that another push to repeal and replace ObamaCare was “off the table.”

“The president wanted to make another run at repeal and replace and I told the president that’s off the table,” Schumer said in a statement on his call with Trump on Friday, news of which the president confirmed in a tweet.

“If he wants to work together to improve the existing health care system, we Democrats are open to his suggestions. A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs,” Schumer added.

If Democrats do work with Trump, they will have to make sure that they are not just enabling him to further reduce health care coverage. On the other hand, if Trump is really willing to diverge from Republican orthodoxy, rather than demanding preservation of the Affordable Care Act the better course would be to promote a single payer plan as proposed by Bernie Sanders. While unlikely to happen, Donald Trump just might go for the idea of going down in history for delivering such a great accomplishment while president.